Lin A-S, Chang S-S, Lin S-H, Peng Y-C, Hwu H-G, Chen W J
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan.
Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong,Hong Kong Special Administrative Region,People's Republic of China.
Psychol Med. 2015 Jul;45(9):1839-50. doi: 10.1017/S0033291714002931. Epub 2014 Dec 17.
Schizophrenia patients have higher rates of minor physical anomalies (MPAs) than controls, particularly in the craniofacial region; this difference lends support to the neurodevelopmental model of schizophrenia. Whether MPAs are associated with treatment response in schizophrenia remains unknown. The aim of this case-control study was to investigate whether more MPAs and specific quantitative craniofacial features in patients with schizophrenia are associated with operationally defined treatment resistance.
A comprehensive scale, consisting of both qualitatively measured MPAs and quantitative measurements of the head and face, was applied in 108 patients with treatment-resistant schizophrenia (TRS) and in 104 non-TRS patients. Treatment resistance was determined according to the criteria proposed by Conley & Kelly (2001; Biological Psychiatry 50, 898-911).
Our results revealed that patients with TRS had higher MPA scores in the mouth region than non-TRS patients, and the two groups also differed in four quantitative measurements (facial width, lower facial height, facial height, and length of the philtrum), after controlling for multiple comparisons using the false discovery rate. Among these dysmorphological measurements, three MPA item types (mouth MPA score, facial width, and lower facial height) and earlier disease onset were further demonstrated to have good discriminant validity in distinguishing TRS from non-TRS patients in a multivariable logistic regression analysis, with an area under the curve of 0.84 and a generalized R 2 of 0.32.
These findings suggest that certain MPAs and craniofacial features may serve as useful markers for identifying TRS at early stages of the illness.
精神分裂症患者的轻微身体异常（MPA）发生率高于对照组，尤其是在颅面部区域；这一差异为精神分裂症的神经发育模型提供了支持。MPA是否与精神分裂症的治疗反应相关仍不清楚。本病例对照研究的目的是调查精神分裂症患者中更多的MPA和特定的定量颅面部特征是否与操作性定义的治疗抵抗相关。
对108例难治性精神分裂症（TRS）患者和104例非TRS患者应用了一个综合量表，该量表包括定性测量的MPA和头面部的定量测量。根据Conley和Kelly（2001年；《生物精神病学》50卷，898 - 911页）提出的标准确定治疗抵抗。
我们的结果显示，在控制了使用错误发现率进行的多重比较后，TRS患者口腔区域的MPA得分高于非TRS患者，两组在四项定量测量（面部宽度、面下高、面部高度和人中长度）上也存在差异。在这些形态异常测量中，在多变量逻辑回归分析中，三种MPA项目类型（口腔MPA得分、面部宽度和面下高）以及疾病早发进一步被证明在区分TRS患者和非TRS患者方面具有良好的判别效度，曲线下面积为0.84，广义R²为0.32。
这些发现表明，某些MPA和颅面部特征可能作为在疾病早期识别TRS的有用标志物。
